Femoral pathologic fractures are not a poor prognostic factor with appropriate treatment: A retrospective study.

BACKGROUND The prognostic impact of pathologic fractures in patients with bone metastases remains controversial. In this study, we focused on pathologic femoral fractures, which are among the most common and are associated with significant morbidity.

METHODS We retrospectively reviewed cases of pathologic femoral fractures treated at our department between 2008 and 2020. A control group was selected from patients with metastatic bone tumors without pathologic femoral fractures during the same period. The two groups were matched 1:1 using propensity score matching based on age, new Katagiri score, primary cancer type, and TNM stage classification to eliminate selection bias.

RESULTS The pathologic femoral fracture group consisted of 75 patients (mean age, 67 years), and surgery was performed in 66 patients (tumor prostheses, n = 41; hip hemiarthroplasties, n = 9; internal fixations, n = 15; hip disarticulation, n = 1). Nine patients did not undergo surgery because of poor general condition and/or poor prognosis. The control group consisted of 678 patients (mean age, 66 years). The 5-year overall survival rate before propensity score matching was 28 % in both groups (p = 0.53). In the propensity score matching analysis (n = 53 patients per group) using the post-fracture performance status in the new Katagiri score, the survival hazard ratio associated with the pathologic fracture was 0.79 (95 % confidence interval: 0.5-1.3, p = 0.38). Since it has not been established whether performance status in the new Katagiri score is assessed in the pre- or post-fracture status, the score was re-evaluated based on pre-fracture performance status. After matching 59 patients per group, the survival hazard ratio was 0.97 (95 % confidence interval: 0.6-1.6, p = 0.91).

CONCLUSIONS The results of this study suggest that, with appropriate treatment, femoral pathologic fractures may not significantly impact the prognosis of patients with metastatic bone tumors. This highlights the importance of providing appropriate management for pathologic femoral fractures.